Outcomes of Surgical Resection of Sinonasal Malignancy Vary by Age

Background: Sinonasal malignancy makes up a small subset of head and neck cancers. Prognosis for this disease can vary depending on the pathology and location of the tumor. The mainstay for treatment of these malignancies includes surgical resection with adjuvant radiotherapy or chemotherapy if necessary. It is unknown if age plays a role in increasing the risk of developing complications following surgical resection. We aim to analyze the impact of age on surgical and systemic outcomes and complications following surgical resection of sinonasal malignancies including cranial base resection utilizing a large national database.

Methods: The TriNetX United States Collaborative Network database was queried for patients undergoing surgical resection of sinonasal malignancy from 2004 to 2024. While long-term prognosis for sinonasal malignancy varies by type, differences are minimized by analyzing outcomes in the early postoperative period. Patients were grouped in age cohorts of 18–60, 61–80, and 81+ and propensity-score matched based on obesity status, hypertension, smoking status, heart failure, alcohol use, gender, and race. Odds ratios of surgical outcomes (cerebrospinal fluid [CSF] leak, meningitis, mortality, and epistaxis requiring nasal packing) and systemic outcomes (acute myocardial infarction, pulmonary embolism, pneumonia, and stroke) were compared between cohorts at 3 months, 6 months, and 1 year following surgery.

Results: Patients aged 18 to 60 years had increased odds of CSF leak compared with the 81+ cohort at 3 months (OR, 2.622; 95% CI, 1.590,4.322; p < 0.0001) and 6 months (OR, 2.544; 95% CI, 1.601,4.043; p < 0.0001), and 1 year (OR, 2.540; 95% CI, 1.636,3.942; p < 0.0001). Patients aged 61 to 80 cohort had increased odds of CSF leak compared with the 81+ cohort at 3 months (OR, 2.114; 95% CI, 1.317, 3.393; p < 0.002), 6 months (OR, 2.301; 95% CI, 1.466,3.611; p < 0.0002), and 1 year (OR, 2.385; 95% CI, 1.556,3.654; p < 0.0001). There were also decreased odds of epistaxis requiring nasal packing in the 61–80 cohort compared with the 81+ cohort at 3 months (OR, 0.494; 95% CI 0.280,0.874; p < 0.013) and 6 months (OR, 0.584; 95% CI 0.358,0.953; p < 0.03). There was no significant change in the odds of CSF leak when comparing the 18–60 and 61–80 cohorts. There were increased odds of mortality in patients ages 81+ compared with 61–80 at 3 months (OR, 1.648; 95% CI 1.137,2.386; p < 0.008), 6 months (OR, 1.547; 95% CI 1.177,2.033; p < 0.002), and 1 year (OR, 1.748; 95% CI 1.392,2.195; p < 0.0001). We found no significant difference in systemic outcomes between all cohorts.

Conclusion: In patients older than 81 years who underwent cranial base surgery for treatment of sinonasal malignancy, we found a higher incidence of epistaxis, but a lower rate of developing CSF leak compared with the younger cohorts. Interestingly, major systemic complications did not differ between cohorts divided based on age. Considering elevated odds of mortality in older cohorts, in-depth preoperative counseling for this population is suggested to maximize patient safety.

Publication History

Article published online:
07 February 2025